Provider Demographics
NPI:1063677813
Name:WYLLIE, BRUCE ALLEN (ARNP)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:ALLEN
Last Name:WYLLIE
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 S. COLUMBIAN WAY
Mailing Address - Street 2:VA PUGET SOUND HEALTH CARE SYSTEM
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1597
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1660 S. COLUMBIAN WAY
Practice Address - Street 2:VA PUGET SOUND HEALTH CARE SYSTEM
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1597
Practice Address - Country:US
Practice Address - Phone:206-764-2051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60027401363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily